Technologist Track

SCMR 22nd Annual Scientific Sessions

2 - Aortic root surgery is associated with deterioration in left ventricular function and physical quality of life

Presenter(s)

• 

  Alaine Berry, MSc

  Senior Research Radiographer
  MRC London Institute of Medical Sciences

Author Only(s)

• OJ

  Omar Jarral, PhD

  Research Fellow
  Imperial College London
• TD

  Tim Dawes, PhD

  Research Fellow
  MRC London Institute of Medical Sciences
• BS

  Ben Statton, MSc

  Superintendent Research Radiographer
  MRC London Institute of Medical Sciences
• MQ

  Marina Quinlan, MSc

  Senior Research Radiographer
  MRC London Institute of Medical Sciences
• TA

  Thanos Athanasiou, MD, PhD, MBA

  Professor Of Cardiovascular Sciences & Cardiac Surgery
  Imperial College London
• DO

  Declan O'Regan, PhD

  Consultant Radiologist
  MRC London Institute of Medical Sciences

Background: Successful surgical intervention in the aortic root, for aortic valve regurgitation or stenosis, is reported to improve symptoms and life expectancy. However, the development of health-related quality of life (HRQOL) measures allows a more comprehensive understanding of the impact on patients than post-operative mortality rates alone. This study sought to describe the changes in volumetric and HRQOL scores after successful aortic root surgery.

Methods:

Patients scheduled for elective aortic root surgery at four centres were recruited prospectively and underwent CMR pre- and eight weeks post-operatively using a Philips 1.5T Achieva (Best, Netherlands) with a 32-channel cardiac coil. Long axis balanced steady state free procession (bSSFP) cines were acquired in the 2 chamber and 4 chamber orientations. A left ventricle short axis (LVSA) bSSFP cine stack was then acquired with these parameters: field-of-view 320 x 352mm; repetition time= 3ms; echo time= 1.5ms; slice thickness= 8mm; slice gap= 2mm; echo train length= 13; flip angle 60◦.

The LVSA images were analysed using CVI⁴² (Circle Cardiovascular Imaging, Calgary, Canada), to ascertain standard clinical CMR measures. The volume and mass measurements were indexed for body surface are (BSA).

All patients were asked to complete the SF-36 quality of life questionnaire at baseline and one year post-operatively. Scores were calculated from the patients’ responses using QualityMetric (Optum, Minnesota, USA).  

Data were analysed in R 3.4.0. Pre- and post-operative data were compared by Wilcoxon two-sample tests as data were positively skewed. Two-sided significance of <0.05 was used to indicate significant results.

Results: 19 patients were recruited, (16 males, median age 60 years, interquartile range (IQR) 51.5-67) with median EuroSCORE (cardiac surgery risk index) of 4.7 (IQR 3.7-7.3). One patient died before one year follow-up. All other patients completed scanning and questionnaires. Physical quality of life (median change -5.1, IQR -9.1 – -1.0, p=0.02), cardiac index (3.5 vs 2.7L/min/m², p=0.002) and stroke index (52 vs 45ml/m², p<0.001) were all lower at follow-up though mental-health quality of life improved (median change +6.1, IQR -+2.1 – +11.6, p=0.03). The correlation between change in mental-health and physical quality of life scores was not significantly correlated (r=0.15, p=0.53).

Conclusion: Elective aortic root surgery is associated with improvements in mental-health quality of life despite poorer physical quality of life and cardiac function. Better understanding of the benefits of high-risk elective surgery may improve patient selection and post-operative symptoms.